Thursday, October 8, 2015

Wishful Thinking – Putin, Trump, and Medicare Premiums

Wishful thinking is thinking based on the belief that you will be pleased with what you imagine will happen rather than what is really happening based on evidence, rationality, and reality.

We are all victims of this misplaced optimism.

Examples are:

1) Putin’s aggressive actions in the Middle East. He can’t possibly mean what he says or does – confronting Obama and telling U.S. to get out of way, putting troops and military equipment in Syria to prop up that horrendous dictator, President Assad, the cause of 250,000 deaths and 4 million immigrants. Surely Putin bluffs. Surely with Russia'sfaltering economy and NATO’s condemnation, Putin knows he is stumbling into another Mid Eastern quagmire. Surely Putin will have second thoughts.

2) The media’s and the Republican establishments’ oft-quoted opinion that Trump’s presidential bid will surely end with a bombastic and dramatic collapse when people regain their senses. Given his narcissistic, assertive, and against-the-grain proposal he will surely self-destructive. But what will happen if Trump continues to lead in all the primaries and gathers enough delegates to win the nomination . What if Hillary withdraws from the race due to an FBI indictment or due to losses in New Hampshire, Iowa, and South Carolina? What if Trump trumps Sanders, Biden, and Maloney? What then?

3) And what about those projected monthly premium spikes from $104.90 to $159.30 for individuals and $318.60 for a family? Surely that can’t be. Surely Democrats and Republicans alike will move to protect Medicare recipients, a vital voting bloc, against such 52% premium increases they can ill afford. Up until now, Medicare enrollees have been a protected species, insulated against rising health costs. Look at the bright side. Seven of ten Medicare recipients will continue to pay $104.50. Only 30%, among them new Medicare enrollees, those with incomes over $85.000 per individual and $170,000 per family, will have to cough up for premium increases. Surely goodness, mercy, political survival, and social justice will prevail over the health costs of longer lives, rising costs of prescriptions, and higher health costs for outpatient, preventive care, durable medical equipment, and ambulance rides. Surely we will get what we wish for.

Wednesday, October 7, 2015

Obama Orwellian Doctrine

War is peace. Freedom is slavery. Ignorance is strength.

George Orwell (1903-1950), 1984

My way is highway.

Blame is transferable.

Failure is success.

Freedom is regulation.

Apology is Americana.

Tuition is unfair.

Taxation is redistribution.

Wealth is unjust.

Debt is justice.

Capitalism is exploitation.

Socialism is OPM (see below)

Taxation is freedom.

Ego is id.

Compromise is veto.

Reset is sunset.

Rhetoric is action.

Minority is majority.

Right is wrong.

Left is right.

Bottom-up is top-down.

Division is agreement.

Victory is quagmire.

Behind is ahead.

Stagnation is progress.

Recession is prosperity.

Indecision is decisiveness.

Retreat is advance.

Vacuum is fullfillment.

Abstract is concrete.

Delusion is reality.

Disapproval is approval.

OPM - Other Peoples' Money

Physicians and Freedom to Practice

Among physicians, a widespread belief persists that ObamaCare restricts their freedom to practice.
For more on this belief,

One, view the video featuring Michael D. Strickland, MD. Committee chair of United Physicans And Surgeons Association. The video address bears the title, “If We Are Not Free, We Are Not American,: and be obtained by clicking on

Two, visit, for easy and free viewing of45+ Speakers 30+ Hours of Content 30+ Medical and Other Organizations and Key Ideas, Resources and Solutions, and their links,to regain control of our own profession as physicians, and our own healthcare, as patients.

Three, read the following article from today’s Kaiser Health News

Whistleblower Doctor Warns About Hospitals Hiring Physicians

By Jay Hancock October 7, 2015

There is a good chance that your once-independent doctor is now employed by a hospital. Dr. Michael Reilly, a Fort Lauderdale, Fla., orthopedic surgeon, does not believe this is good for physicians, patients or society.

For years he watched Broward Health, a nonprofit Florida hospital system, hire community doctors, pay them millions and minutely track the revenue they generated from admissions, procedures and tests.

“We are making money off these guys,” Broward Health’s CEO told Reilly, according to a federal whistleblower lawsuit filed against the system by Reilly and the U.S. Justice Department.

Last month Broward Health agreed to pay $70 million to settle allegations that it engaged in “improper financial relationships” with doctors under laws prohibiting kickbacks in return for patient referrals.

Giving doctors incentives to generate medical revenue is widely deemed unethical because it tempts them to order unneeded treatment or send patients to lower-quality providers. Physicians with a financial interest in a medical facility tend to prescribe more procedures than those who don’t, studies show.

Lawmakers have repeatedly tried to ban or limit such behavior at least since the 1970s. What happened at Broward Health and numerous other hospitals suggests they haven’t succeeded. Now that hospitals everywhere have gone on their own physician acquisition sprees, Reilly worries the same thing will keep occurring.

“We have got to get hospitals out of the business of hiring doctors,” he said in an interview. “It’s potentially detrimental to the patient, and it’s terrible for health care.”

Hospitals, burdened with large, fixed costs and anxious to ensure patient referrals and revenue in a changing industry, are doing the opposite.

“Doc binge buying rolls on” was the June headline in Modern Healthcare, an industry magazine. A third of doctors now work directly for hospitals or for practices with at least partial hospital ownership, estimates the American Medical Association.

Broward Health is a taxpayer-supported system with five hospitals and a publicly appointed board.

More than a decade ago it launched an expansion drive that included hiring previously independent physicians and paying CEO Frank Nask and other executives large bonuses if the institution increased revenue and the bottom line.

It agreed to hire orthopedists and cardiologists for more than $1 million a year — far more than average for such specialties. It paid orthopedic surgeon Dr. Erol Yoldas, also team doctor for the Florida Marlins baseball team, nearly $1.6 million in 2009.

Reilly rejected an employment deal with Broward Health after his lawyer told him it was illegal, he said. His whistleblower complaint, originally filed in 2010, was unsealed last month.

The system carefully tracked the return on its investment in the other doctors, recording the value of referrals and pressuring them to increase volume if they lagged, the lawsuit said.

Although Broward Health paid an enormous sum to settle allegations of wrongdoing, it did not admit those allegations, which is typical in such cases. CEO Nask retired last year. Nobody in the system has been charged with criminal wrongdoing.

Yoldas did not respond to requests for interviews. Nask did not respond to messages left at a number listed in his name.

Thanks to an uncoordinated system that pays for procedures instead of keeping people healthy, 30 percent of U.S. health care dollars spent in 2009 were wasted on unnecessary treatment, excessive administrative costs or fraud, calculates the authoritative Institute of Medicine.

Reilly responds carefully when asked whether doctors employed by Broward Health were ordering unneeded procedures. He’s concerned about possibly getting sued by a system with “deep coffers,” he said.

“I wasn’t allowed to review medical records,” he said. But when he sometimes saw patients who had been recommended for surgery by those doctors, he added, “I never agreed with the previous opinions.”

Reilly preferred working as an independent — on staff at hospitals but not employed by them. He didn’t feel compelled to generate revenue by ordering procedures, he said.

If Broward Health pushed a brand of artificial knee he felt was wrong for a patient, he could do the operation elsewhere. If he had concerns about the system’s radiology department — as some doctors did, according to the lawsuit — he could refer people to a different facility.

Fewer and fewer doctors have the same freedom, Reilly worries.

Some believe the AMA underestimates the portion of physicians employed by hospitals. Hospitals have been especially keen to hire primary-care doctors, the specialty that generated the highest referral profits for Broward Health, according to the lawsuit.

Not only does hospital employment “dramatically” boost chances that a doctor will refer to that hospital, but it also raises odds that patients will end up at a higher-cost, lower-quality facility, finds a recent study from Stanford University researchers. Like Broward Health CEO Nask, many hospital bosses get bonuses for increasing revenue and profits.

In the last two years the Justice Department has settled more than a dozen cases under the Stark law, which prohibits improper financial inducements to doctors in return for patient referrals.

“My wish would be that the hospital-physician employee contract would go away,” said Reilly, now retired and entitled to $12 million of the whistleblower settlement. “You could pick just about any hospital, and I will tell you there is a component where that contract is driven by referrals.”

He is skeptical that accountable care organizations — collaborative groups of doctors and hospitals that are supposed to focus on keeping patients healthy and not on maximizing revenue — will change the dynamic.

Hospital hiring of physicians “not only fosters an environment to motivate physician referrals, but also blunts physician innovation, discovery and ingenuity,” he said.

What should patients do? Ask their doctor who he or she works for, Reilly added. If the doctor is employed by the hospital and recommends surgery or some other expensive treatment, he said, “research the indications for the procedure” and “consider a second opinion” from an independent practitioner.

IBM’s Eight Page "Ad-Mission"

An “Ad-Mission” is an advertisement with a mission.

When I opened the lead section of today’s Wall Street Journal, I could hardly believe my eyes. Tucked inside was an eight page IBM advertisement welcoming the Cognitive Era – a new era of technology, a new era of business, a new era of thinking.

This ad-mission extends and celebrates IBM’s basic slogan – Think. What the ad is saying is that you can’t think without computers, and with computers you outthink your competitors.

Page 1 is saying: It’s elementary, my Dear Watson. Watson is IBM’s thinking computer. Watson is the name of IBM’s founder. Watson is the sidekick of Sherlock Holmes, Doctor Watson. If you’re an ad man, it all fits.

Page 2 proclaims that 3 historic shifts have created businesses that can only think with the aid of Cognitive Computers. The shifts are 1: A World Awash in Data. 2: A World Reinvented in Code. 3 The Advent of Cognitive Computing. “Cognitive” is the new word for “Thinking.” And in business, you need to have Cognitive Engagement, Cognitive Products and Services, and Cognitive Processes and Operations, Cognitive Expertise, and Cognitive Exploration and Discovery.

Page 3- Advances the proposition that IBM Watson understand reasons and learns, and in a sense, think. Watson has 28 cloud-based applications , everything from soup to nuts.

Page 4 - Watson can analyze meaning and context of data in clinical notes and reports, combine data from patient’s files with clinical expertise and research,, and identify best treatment plans.

Page 5 - Watson can identify “hot” products and combine predictive with demographic data to reduce out-of-stock situations,

Page 6- Watson can outthink sports executives on who to draft and who to trans, can outthink energy experts on what alternative energies to use, can outthink those who file fraudulent insurance claims, and can outthink educators by helping tem spot students at risk of dropping out.

Page 7 - Watson can help executive by identifying risky and profitable merger and acquisition deals.

Page 8 - Watson can make businesses ready to design cognitive strategies, make analytics more useful. Help businesses move to the cloud, build a cognitive infrastructure , and make data more secure.

The mission described in all of these patients is designed to help businesses outthink and outperform ordinary human and to make businesses extraordinarily successful.

IBM’s cognitive outthinking human campaign should be considered in the context of IBM’s weak stock market performance with 13 straight quarters of decline in quarterly revenues and sharp drops in market caps as IBM invests heavily in cloud computing and data analytic technology to boost its declining personal computer business.

IBM’s future is in the cloud, but it depends on numbers on the ground

Tuesday, October 6, 2015

Who Is the Silent Majority?

The Great Silent Majority.

Richard Nixon (1913-1994). Speech. 1969

“Silent majority” is an unspecific large majority in a group or a country who do not express their opinion publicly.

“Silent majority” is a term made famous in 1969 by President Richard Nixon when he asked for public support for ending the Vietnam War.

“Silent majority” is perceived by progressives to be a not-so-subtle reference to conservative white people - evangelicals, Tea Party members, and Republicans - particularly in the South and Midwest – who disagree with liberal policies but who are either too stupid or too inarticulate to say so.

"Silent majority" is thought of by conservatives as people on their side of the political ledger who have
make up their base but who not gone to the polls in sufficient numbers to win national Presidential elections.

“Silent majority” is a term frequently evoked by Donald Trump as a group of people who want “to make America great again.” In a recent tweet prior to a gathering of 20,000 people in Alabama Trump tweeted “ We’re going to have a wild time in Alabama tonight! Finally, the silent majority is back.”

Or does the “silent majority” consist of Americans, 61% of whom say the country is headed in the wrong direction, because of a sluggish economy, lack of quality jobs, decline in middle class incomes, an unpopular health law, and disarray, defeats, and lack of strategy in U.S. foreign policy.

Members of the “silent majority” may be most concentrated in the rural American South where poverty , poor education , access to quality health care, and joblessness is most evident and pervasive.

In the rural South, Paul Theroux, comments in his book The Deep South, “the whites feel like a despised minority – different, defeated, misunderstood, meddled with, pushed around, cheated.”

It is in the South, where the most manufacturing jobs have been shipped to China, Mexico, and India. In the South, people feel that rich U.S. capitalists don’t care for them, and that the U.S. government spends more abroad than to destitute Southerners and adds to joblessness through EPA rules that close coal mines and drive up energy costs. And in the South, people feel paranoid and prejudiced against because of their belief in traditional moral values, marriage between man and women, fundamental Christian religions, heterosexual relationships rather than free-flowing secularism where opposite values prevail

Finally, many Southerners feel have been outvoted, outmaneuvered, put-propagandized, and out-organized .
It is to these Southerners and others of like believers, which may include the majority in the Middle Class, that Donald Trump has directed his tweets and his speeches about bringing workers back, sending illegal immigrants, back, about striking winning “deals” with foreign governments, and touting the Bible as his favorite book, with the Art of the Deal as a close second, not necessarily in that order.

Monday, October 5, 2015

Health Care Overuse

It takes a very unusual mind to undertake the analysis of the obvious.

Alfred North Whitehead (1861-1947), Dialogues of Alfred North Whitehead

The obvious, which is not so obvious, and the simple, which is not so simple.

The Practical Cogitator, 1959

This day I ran across a Kaiser Health News article “Wellness Programs: Early Alarms for Workers’ Health or a Recipe for Overtesting.”

Its message is obvious. If you do enough testing for health: you will find something wrong, and you will do more tests to confirm what is wrong. One test leads to another. Little tests lead to bigger tests. One abnormal test results in other tests that were not usually planned.

If you do many tests based on metrics, you will either generate false positives or true positives.

Most test results are based on a mean value, plus or minus 2 standard deviations, a normal range that generally encompass 67% of normal results but with inevitable outliers. This means any metric will include normal results but also abnormals outside the normal range. Borderline abnormals may set off alarms that a worker has health problems that may eventuate in diseases later.

Take the problem known as “metabolic syndrome” – a common problem that may be a precursor to heart disease, stroke, or other cardiovascular disease. The metabolic syndrome is defined as: increased waist size, high triglycerides, low HDL cholesterol, high blood pressure, and elevated blood glucose.

These are relatively common findings in any population of workers. Who among us does not know someone with a belly or expanded waist? Elevated triglycerides are common after even modest ingestion of alcohol or a recent carbohydrate rich meal. One third of Americans have high blood pressure, and one of five are either prediabetic or diabetic.

If tests for these conditions are either “free” or mandated by an employer, it is obvious some of these tests will be abnormal, and may lead to other obvious things- a weight reduction regimen, a full lipid panel, blood pressure medications, or a glucose tolerance test. These follow-up tests are necessary to confirm a diagnosis, or to set a preventive program in motion. Workers may regard such testing as an invasion of their privacy. The testing may result in higher costs.

Screening for wellness and for early signs of disease has its problems. It may result in health care overuse syndromes. When HMOs were introduced, routine visits to the doctor and routine testing were encouraged. When ObamaCare health exchanges took hold and the uninsured were subsidized, 10 million people flocked to exchange plans- an insurers found that many of those subsidized were sicker than thought and cost $1000 more than projected, with heavy losses for insurers with losses with insurers being bailed out by government and middle class taxpayers. When new technologies are introduced - CT scans, angioplasties, joint replacements, insulin pumps, lipid lowering statins or other drugs – they are invariably used to excess.

Offer a new technology, and it will be used. Seek an abnormal result, and it shall be found.